Prevalence and risk factors of hemodynamic instability associated with preload-dependence during continuous renal replacement therapy in a prospective observational cohort of critically ill patients

Abstract Background Hemodynamic instability is a frequent complication of continuous renal replacement therapy (CRRT). Postural tests (i.e., passive leg raising in the supine position or Trendelenburg maneuver prone position) combined with measurement cardiac output are highly reliable to identify preload-dependence and may provide new insights into mechanisms involved hemodynamic related CRRT (HIRRT). We aimed assess prevalence risk factors HIRRT associated ICU patients. conducted single-center prospective observational cohort study patients acute kidney injury KDIGO 3, started on last 24 h, monitored PiCCO® device. The primary endpoint was rate episodes during first 7 days after inclusion. defined as occurrence mean arterial pressure below 65 mmHg requiring therapeutic intervention. Preload-dependence assessed by postural every 4 each episode. Data expressed median [1st quartile–3rd quartile], unless stated otherwise. Results 42 (62% male, age 69 [59–77] year, SAPS-2 [49–76]) were included 6 [1–16] h initiation studied continuously for 121 [60–147] h. A 5 [3–8] occurred per patient, pooled total 243 episodes. 131 (54% [CI 95% 48–60%]) preload-dependence, 108 (44%, 38–51%]) without unclassified. Multivariate analysis (using variables collected prior HIRRT) identified following preload-dependence: before [odds ratio (OR) = 3.82, p < 0.001], delay since episode > 8 (OR 0.56, 0.05), lactate 1.21 1-mmol L −1 increase, index 0.47 1-L min m −2 0.001) SOFA at admission 0.91 1-point 0.001). None settings factor HIRRT. Conclusions In this study, slightly more than undergoing CRRT. Testing could help avoiding unnecessary decrease fluid removal preload-independent